关键词: 腹腔镜, 经腹腔腹膜前疝修补术, 低温, 冰敷, 芒硝

Abstract: Objective To investigate the effect of sequential therapy of low temperature and glauber salt in preventing seroma after laparoscopic transperitoneal preperitoneal hernia repair （TAPP）. Methods Clinical data of 120 TAPP patients admitted to the General Surgery Department of Wan′an County People′s Hospital and Department of Gastrointestinal Surgery and Hernia Center of the Sixth Affiliated Hospital of Sun Yat-sen University from March 2019 to March 2022 were collected and divided into the study group and the control group with 60 patients in each group by using a computer random number table. In the study group, 200 mL 4℃ saline irrigation was applied to the inguinal area, ice packs compress two hour postoperatively in the inguinal area and two day external application of glauber salt after surgery. In the control group, conventional TAPP postoperative treatment was performed. The main outcome indicators were the incidence of postoperative seroma in two groups, while the secondary outcome indicators included operation time, out-of-bed activity time, length of stay, hospitalization cost, incision pain, VAS score, incidence of malignant vomiting, urinary retention and intestinal obstruction, and long-term follow-up indicators included chronic pain, mesh infection and hernia recurrence. Results The incidence of seroma in study group and control group was 1.7% （1/60） and 16.7% （10/60）, respectively, and the difference was statistically significant （P<; 0.05）, 1 in the study group belonged to type ⅰ. In the control group, 6 cases were type ⅰ, 2 cases were type ⅱ and 2 cases were type ⅳ. Type ⅳ seroma was gradually relieved after puncture and aspiration guided by B-ultrasound, while type ⅰ and ⅱ seroma were improved after glauber salt external application. The incidence of postoperative incision pain, nausea and vomiting and urinary retention in the study group were 5.0%, 3.3% and 3.3%, respectively, lower than 16.7%, 13.3% and 15.0% in the control group, and the difference was statistically significant （P<; 0.05）. VAS score （3.1±; 0.6） points, out-of-bed activity time （8.5±; 2.3） h, and length of stay （3.5±; 0.6） d in the study group were all lower than those in the control group （4.8±; 0.8） points, （13.1±; 1.7） h, and （4.5±; 1.0） d, all of which were statistically significant （P<; 0.05）. There were no statistically significant differences between the two groups in terms of operation time, chronic pain in the inguinal region, mesh infection, intestinal obstruction, hospital expenses, and hernia recurrence. Conclusion The sequential therapy of low temperature and glauber salt can effectively prevent the occurrence of seroma after TAPP, with fewer complications, significantly reduce the postoperative pain of patients,promote rapid recovery, and do not increase the economic burden of patients, which is worthy of clinical application and promotion.

Key words: laparoscopy, transabdominal preperitoneal hernia repair, low temperature, ice compress, glauber salt